RESUMO
BACKGROUND: Recent studies have demonstrated that black patients receive substandard care compared with white patients across healthcare settings. The purpose of this study was to evaluate the association of race on the management (salvage vs. amputation) of traumatic lower extremity open fractures. METHODS: Data analysis was conducted using the American College of Surgeon's National Trauma Data Bank. Open tibial and fibular (OTFF) and open femoral (OFF) fractures among adults above the age of 18 were identified by International Classification of Diseases, 9th Revision codes. Injuries were identified as amputated based on the presence of one of three types of knee amputations. Statistical analysis included logistic regression stratified for sex, age, race, mechanism of injury, severity, and insurance type. RESULTS: From the National Trauma Data Bank, 10,082 OFF and 22,479 OTFF were identified. Amputation rates were 3.1% for OFF and 4.2% for OTFF. With age stratification, the ratio of amputation odds for blacks to amputation odds for whites (i.e., the Racial Odds for Amputation Ratio [ROAR]) demonstrated a significant interaction between black and age in both the OFF (p = 0.028) and OTFF (p = 0.008) groups. In younger patients, a lower ROAR (p = 0.016) favored salvage in blacks, while the ROAR in older patients favored amputation in blacks (p = 0.013). The higher prevalence of penetrating injuries in blacks only accounted for 12.7% of the lower ROAR among younger adults. CONCLUSIONS: There exists a racial disparity in the management of lower extremity open fractures. Older blacks have greater odds of amputation that is not explained by mechanism. In contrast, younger blacks have lower odds for amputation that is only partially explained by mechanism of injury.
Assuntos
Amputação Cirúrgica/estatística & dados numéricos , Fraturas Expostas/cirurgia , Disparidades em Assistência à Saúde/etnologia , Traumatismos da Perna/cirurgia , Adolescente , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Fatores Etários , Amputação Cirúrgica/métodos , Bases de Dados Factuais , Feminino , Fraturas do Fêmur/diagnóstico , Fraturas do Fêmur/etnologia , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/métodos , Fixação Interna de Fraturas/estatística & dados numéricos , Fraturas Expostas/diagnóstico por imagem , Fraturas Expostas/etnologia , Humanos , Incidência , Escala de Gravidade do Ferimento , Traumatismos da Perna/diagnóstico , Traumatismos da Perna/etnologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prognóstico , Radiografia , Estudos Retrospectivos , Medição de Risco , Fraturas da Tíbia/diagnóstico , Fraturas da Tíbia/etnologia , Fraturas da Tíbia/cirurgia , Resultado do Tratamento , Estados Unidos , População Branca/estatística & dados numéricos , Adulto JovemRESUMO
Open pelvic fractures have a greater than 40% mortality rate. Traumatic hemipelvectomy, a severe form of open fracture, is a life-threatening injury that requires rapid resuscitation, surgical intervention, and critical-care monitoring. Survivors benefit from aggressive and consistent rehabilitation. This case presentation discusses the multiple aspects of care of a traumatic hemipelvectomy and the ways in which the staff were able to accommodate the cultural needs of an Amish patient and family.
Assuntos
Fraturas Expostas/etnologia , Fraturas Expostas/enfermagem , Hemipelvectomia/enfermagem , Ossos Pélvicos/lesões , Adolescente , Cristianismo , Cuidados Críticos , Enfermagem em Emergência , Humanos , MasculinoRESUMO
We describe fives cases of an unusual type of injury to the wrist which has been seen in Sikhs, an ethnic population in India. It is caused by entrapment of the kara, an iron bangle, which is traditionally worn as one of five compulsory religious symbols. The injuries were an open transtriquetral palmar perilunar dislocation, a double palmar radiocarpal dislocation, and a compound, grossly displaced anterior Galeazzi fracture-dislocation. Two cases had unclassified injuries.
